O objetivo deste artigo é explorar como as metodologias ativas e as tecnologias educacionais, sobretudo as digitais, podem fomentar uma participação mais ativa dos alunos em seu processo de aprendizagem e sugerir possíveis mudanças nas práticas pedagógicas. O blended learning, concebido em sentido mais estrito como o mix de atividades presenciais e online, e, em um sentido mais amplo, como o mix de diferentes metodologias e espaços, pode ser considerado o futuro das atividades educacionais. As seguintes metodologias são discutidas: sala de aula invertida, instrução de pares, aprendizagem baseada em problemas, aprendizagem baseada em projetos e aprendizagem baseada em jogos. A investigação mostra que estas metodologias, quando combinadas adequadamente com as tecnologias de informação e comunicação, resultam numa maior motivação e envolvimento dos alunos. Embora essas estratégias não gerem melhora na retenção imediata do conhecimento, são desenvolvidas habilidades mais complexas quando comparadas aos métodos tradicionais de ensino, como: resolução de problemas, transferência do conhecimento para a realidade e retenção do conhecimento em longo prazo. O artigo conclui com uma crítica aos discursos contemporâneos que colocam o aluno no centro do processo de ensino e aprendizagem, reivindicando uma pedagogia descentralizada, na qual os alunos interagem uns com os outros, professores e outros atores, em grupos colaborativos onde não há necessidade de um centro, ou em que cada um desses atores pode, alternativamente, desempenhar uma função central.

Background: Behavioral Activation (BA) is an evidence-based treatment that aims to help the individual to stay active and reduce avoidance behaviors, as a means to reduce depressive symptoms. This study aims to describe the adaptation process and evaluate the psychometric properties of the Behavioral Activation for Depression Scale Short Form (BADS-SF) in its Brazilian and Peruvian version. Methods: Data were collected as part of a randomized trial with 880 participants in Brazil and 432 in Peru. The content validity was assessed using the Content Validity Index (CVI). Principal Component Analysis (PCA) method was applied to evaluate the factorial distribution. Sampling adequacy was assessed by Bartlett’s test of Sphericity and Kaiser-Meyer-Olkin measure. Cronbach’s alpha coefficient was calculated to assess internal consistency. Results: CVI in Brazil was 0.92 and in Peru 0.87. The two-factor solution of the original scale is sustained (activation and avoidance), accounting for 50.6 and 54% of the total variance in Brazil and Peru, respectively. Cronbach’s alpha in Brazil was 0.55 and 0.66 in Peru for the overall scale. KMO was 0.769 and 0.790 for Brazil and Peru, respectively. Bartlett’s test of Sphericity had significance of 0.000 for both samples. Conclusion: Both studied versions of the BAD-SF showed coherent structure and internal consistency. We recommend different distribution of the items into the subscales.

Background Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. Methods We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. Results We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other’s experiences. Conclusion Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).

Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top–down and bottom–up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426 DERR1-10.2196/26164

BACKGROUND Mobile health (mHealth) interventions provide significant strategies for improving access to health services [1], offering one potential solution to reduce the mental health treatment gap. Economic evaluation can contribute with evidence to the local policy of and program development in mental health. OBJECTIVE This paper presents the protocol for an economic evaluation conducted alongside two randomized controlled trials (RCTs) to evaluate the effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes and/or hypertension. METHODS The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO compared to usual enhanced care from society and public health system perspectives. We recruited participants from the public health systems in Sao Paulo, Brazil (n=880), and Lima, Peru (n=432), and randomized to intervention or enhanced usual care groups RCTs. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost to decrease depressive symptoms by 50% or more. The cost per quality-adjusted life-year (QALY) gained. For effectiveness, our primary outcome is the proportion of participants with a 50% reduction in the Patient Health Questionnaire (PHQ- 9) score at 3-month - calculated through logistic regression. For utility, our primary outcome is the QALYs gained, measured by the EQ-5D-3L. We assessed each dimension at months 3 and 6. Costs will include both direct and indirect costs. The method of measurement will be mixed methods, with a combination of the Top-down and Bottom-up approaches. We will collect unit costs from the RCTs and national administrative databases. We will also calculate incremental cost-effectiveness ratios (ICERs) and display 95% confidence intervals (CI) from non-parametric bootstrapping (1000 replicates). We will calculate the incremental cost-effectiveness rate, as well as a deterministic and probabilistic sensitivity analysis. Finally, we will draw a Cost-Effectiveness Acceptability Curve (CEAC) to compare a range of possible cost-effectiveness limits. RESULTS The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. CONCLUSIONS We expect to assess if CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared to usual enhanced care. This study will assist health managers in allocating additional resources for mental health initiatives and will inform policymakers. It also provides a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low-income settings. CLINICALTRIAL ClinicalTrials.gov - Brazil NCT02846662 and Peru NCT03026426

Background: Task-shifting and eHealth have been proposed as ways of approaching the mental health treatment gap in low and middle-income countries (LMIC). The Latin America Treatment & Innovation Network in Mental Health (LATIN-MH) developed CONEMO (Emotional Control), a behavioral intervention used to treat depressive symptoms in a sample of patients with diabetes and hypertension in Sao Paulo, Brazil. The intervention uses task shifting and is delivered via a smartphone app. The effectiveness of this intervention was tested in two randomized trials in these countries. Aim: This paper aims to present the protocol for a study that will explore perceived barriers and facilitators to implementing this intervention to help future scale-up. Methods: We will conduct qualitative research with users of the CONEMO intervention and health professionals who participated directly and indirectly in the trial in Brazil. We will use semi-structured interviews, and we will adopt the Consolidated Framework for Implementation Research (CFIR) for data analysis. Discussion: Task-shifting and eHealth are potentially important tools to help decrease the mental health treatment gap in Latin America. This study will increase our understanding of the factors which may facilitate or hinder the implementation of mobile behavioral mental health interventions, using task-shifting, within LMICs. Findings could be used in future design and planning to facilitate successful implementation and treatment. Registration in Clinical Trials (www.clinical.trials.gov) NCT028406662

The Sustainable Rural Water Supply and Sanitation Sector Project of Nicaragua aims to: (a) to increase the access to sustainable WSS services in selected poor rural areas of Nicaragua through the consolidation of rural WSS sector institutions and the provision of adequate infrastructure; and (b) to improve Nicaragua’s capacity to respond promptly and effectively to an eligible emergency. Potential negative impacts may occur because of the presence of Indigenous and Afro-Nicaraguan Peoples in the project area. An indigenous and Afro-Nicaraguan Peoples Planning Framework (IAPPF) will be prepared by the EMERGENCY SOCIAL INVESTMENT FUND (FISE), and Indigenous and Afro-Nicaraguan Peoples Plans (IAPP) will be submitted for approval prior to the construction of any public works.

The Sustainable Rural Water Supply and Sanitation Sector Project of Nicaragua aims to: (a) to increase the access to sustainable WSS services in selected poor rural areas of Nicaragua through the consolidation of rural WSS sector institutions and the provision of adequate infrastructure; and (b) to improve Nicaragua’s capacity to respond promptly and effectively to an eligible emergency. Potential negative impacts may occur because of the presence of Indigenous and Afro-Nicaraguan Peoples in the project area. An indigenous and Afro-Nicaraguan Peoples Planning Framework (IAPPF) will be prepared by the EMERGENCY SOCIAL INVESTMENT FUND (FISE), and Indigenous and Afro-Nicaraguan Peoples Plans (IAPP) will be submitted for approval prior to the construction of any public works.

The Sustainable Rural Water Supply and Sanitation Sector Project of Nicaragua aims to: (a) to increase the access to sustainable WSS services in selected poor rural areas of Nicaragua through the consolidation of rural WSS sector institutions and the provision of adequate infrastructure; and (b) to improve Nicaragua’s capacity to respond promptly and effectively to an eligible emergency. Potential negative impacts may occur because of the presence of Indigenous and Afro-Nicaraguan Peoples in the project area. An indigenous and Afro-Nicaraguan Peoples Planning Framework (IAPPF) will be prepared by the EMERGENCY SOCIAL INVESTMENT FUND (FISE), and Indigenous and Afro-Nicaraguan Peoples Plans (IAPP) will be submitted for approval prior to the construction of any public works.

A Analise de Risco (AR) e um instrumento preconizado pela Organizacao Mundial de Saude Animal (OIE) para que os paises-membros interessados a utilizem para buscar um nivel adequado de protecao na sanidade de seus rebanhos. Empregada ha pouco mais de uma decada na area da saude animal e, portanto, considerada uma tecnica recente, o uso da AR tem crescido rapidamente dentro dos Servicos Veterinarios Oficiais (SVO) dos paises e hoje e utilizada rotineiramente para avaliacao, mensuracao e mitigacao de riscos. Alem da AR de importacao, outras relacionadas com a introducao de patogenos por animais silvestres de vida livre e aves migratorias, bioterrorismo, sistemas de vigilância e tambem com a saude publica, tais como agua e animais de companhia, tem sido relatadas por diversos SVO no mundo. Em 2012, o Departamento de Defesa Agropecuaria da Secretaria da Agricultura, Pecuaria e Agronegocio e a Superintendencia de Agricultura do Rio Grande do Sul do Ministerio da Agricultura, Pecuaria e Abastecimento em conjunto com o Laboratorio de Epidemiologia Veterinaria da Universidade Federal do Rio Grande do Sul iniciaram uma AR utilizando a tecnica de analise multicriterios para avaliar as areas com maior probabilidade de entrada do virus da febre aftosa (VFA) no RS e as suas consequencias (ou seja, areas de maior risco), bem como propor medidas de mitigacao. Inicialmente, utilizando uma adaptacao da tecnica de priorizacao de riscos (risk priority number), foi efetuada a classificacao dos caminhos com maior risco para a entrada e disseminacao do VFA no RS. Posteriormente, foram definidas 28 variaveis para compor a analise multicriterio, visando a caracterizar as areas de maior risco para a doenca. A ponderacao dos pesos por variavel foi realizada pela consulta de 13 especialistas da area. Utilizando-se os dados das variaveis e de seus respectivos pesos, com a utilizacao do software Idrisi® versao Selva, foram modelados os mapas de probabilidade de introducao, probabilidade de disseminacao e de risco da febre aftosa no RS nos municipios. Ainda, a partir de outras quatro variaveis e dos seus respectivos pesos, foi avaliado o sistema de vigilância no Rio Grande do Sul, que foi incorporado ao modelo de risco, resultando numa caracterizacao espacial das regioes com seu respectivo risco residual para a febre aftosa. Esse estudo podera auxiliar tecnicamente os tomadores de decisao a determinar medidas que possam mitigar o risco da introducao e disseminacao do VFA nas areas de maior risco no Estado e, ainda, na decisao de se alterar o status sanitario para a febre aftosa, passando para area livre de febre aftosa sem vacinacao, o que possibilitara a abertura de novos mercados para os produtos da pecuaria gaucha.

This study was aimed to investigate basic issues related to childhood obesity in the School Zulmira de Novais. The research has a qualitative and quantitative approach, aiming to predict the profile of students aged 7a nine years, where 105 students tested found a percentage of 34.28% were obese or overweight. Regarding eating habits became clear that students have habits that go against the scientific literature and advised by the World Health Organization WHO, where this intervention has an educational bias against childhood obesity is increasing alarmingly across social strata of the population clear that the project does not have the intention to take a role to fill space, more contribute to an awareness of the critical perspective and participatory population investigated in both sexes, now one theoretical contribution, sometimes with a practical contribution. which addresses issues of physical education and childhood obesity, seeking to dissolve prejudices and appreciating body expression and healthy eating habits, condensing actions taken in school from the perspective of a practical theoretical foundation that address necessary changes to reduce childhood obesity in the framework of this academic institution , indicating a shared across all disciplines work. where anthropometric measures of body mass and stature BMI, comply with the percentile distributions proposed by NAHANES 2003, according to sex and age, because anthropometry is considered an important diagnostic method in population studies, although they vary the criteria used. Ready is permissible constitute an offer for Physical Education lessons, which take into account the element of study is the Body Culture Movement, and are guided by their philosophical vision. Where Physical Education as an area of knowledge of Health should be covered as a Health Promoter discipline of not disease prevention and, as a consequence, the axes of sports content, dances, fights, and gymnastics that are part of PCNS of Physical Education must be approached as causative elements of situations that excite the student in understanding his role as a builder of your own health knowledge. To enhance this project beyond the contribution of other disciplines, we sought family partnership to consolidate

Este artigo traca o perfil da Industria Cultural, fenomeno marcante da sociedade industrial capitalista, a partir da leitura de algumas obras dos pensadores da Escola de Frankfurt. Defende a ideia de uma teoria estetica aliada a uma teoria critica como contrapartida aos efeitos da cultura massificada, bem como demonstra que, se a educacao trabalhasse apartir da experiencia estetica, aliada a producao cognitiva, estaria buscando alternativas para superar a bestializacao generalizada, a qual Adorno denomina “barbarie estilizada”. PALAVRAS-CHAVE: Escola de Frankfurt. Industria cultural. Ideologia. Alienacao. Teoria Estetica.

Esta comunicacao apresenta um recorte de uma pesquisa de doutorado na qual atentou-se para as perspectivas pelas quais o fenomeno do ensino e aprendizagem da geometria se da nas vivencias de sujeitos em um curso de extensao abordando aspectos da geometria espacial, em particular as relacoes entre os entes geometricos. Assumindo a fenomenologia hursseliana no que diz da visao de conhecimento e de mundo, a questao diretriz da pesquisa assim se apresenta: Como se da o ensino e a aprendizagem da geometria assumida nos aspectos de compreensoes pre-predicativas e nos encaminhamentos que direcionam para uma producao geometrica? Tal questionamento indaga pelos modos como os sentidos e os significados para as ideias e conceitos geometricos abordados sao constituidos na temporalidade das vivencias, nao tendo como foco uma explicacao linear e deterministica de passos a serem dados por uma individualidade que aprende. Nesta comunicacao, destacamos a compreensao fenomenologica quanto ao conhecimento pre-predicativo e alguns aspectos de vivencias espaciais dos sujeitos da pesquisa, focando na possibilidade de uma producao em geometria.

Objetivos: determinar o número de indivíduos com fissura labiopalatina não sindrômica (FLPNS) no núcleo familiar; determinar a presença de consanguinidade parental na presente casuística; descrever as eventuais anomalias menores observadas na amostra; e, estimar os riscos de recorrência familial para probando/filhos, nos diferentes grupos de fissura labiopalatina.Metodologia: O estudo retrospectivo e prospectivo constituiu uma amostra de 841 indivíduos, cadastrados no HRAC/USP.Os critérios mínimos para a inclusão foram: presença de FLPNS e existência de filhos (exceto os adotados) dos probandos.A amostra foi dividida em dois grupos, Grupo I: probandos com fissura de lábio com ou sem fissura de palato (FL+/-FP) e Grupo II: probandos com fissura de palato (FP

Most patients with Kabuki syndrome (KS) are the only person in their family with the condition. However, familial cases of KS have been described showing evidence that this syndrome can be inherited as a dominant trait with variable expressivity. We report on two related individuals with facial findings characteristic of KS. The proposita had arched eyebrows, long and upward slanting palpebral fissures, cleft lip and palate, retromicrognathia, brachydactyly of hands and feet, stubby fingers, nail hypoplasia, and prominent finger pads. Her mother had eyebrows with dispersed lateral half, long and upward slanting palpebral fissures, retrognathia, abnormal and posteriorly rotated ears, prominent finger pads, brachydactyly of feet, learning difficulties, and psychomotor development delay. DNA sequencing revealed a novel missense mutation in the MLL2 gene in both the proposita and her mother. The mutation (p.R5432Q) was found in the exon 51, within the SET domain of the gene, which confers methyltransferase activity on the protein. Therefore, the epigenetic and transcriptional regulatory properties of this protein may be altered and this suggests that the mutation is the cause of phenotype observed in both the patient and her mother. The clinical signs and the molecular evidence in this family further support the notion that KS is an autosomal dominant condition with variable expressivity. To our knowledge this is the first report of a Brazilian family with recurrence of this syndrome. © 2012 Wiley Periodicals, Inc.

Este documento fue comisionado por la Red de Reduccion de la Pobreza y Proteccion Social del Dialogo Regional de Politica para la VII Reunion Hemisferica celebrada los dias 11 y 12 de noviembre de 2004. Presentamos aqui los principales cambios introducidos en el financiamiento de la salud y la educacion en Brasil en el periodo comprendido entre 1995 y 2002, los cuales produjeron avances importantes en el desempeno reciente de estos sectores y cuyo impacto se prolongara en el futuro, especialmente en lo que tiene que ver con la reduccion de los desequilibrios inter e intrarregionales.

The Sustainable Rural Water Supply and Sanitation Sector Project of Nicaragua aims to: (a) to increase the access to sustainable WSS services in selected poor rural areas of Nicaragua through the consolidation of rural WSS sector institutions and the provision of adequate infrastructure; and (b) to improve Nicaragua’s capacity to respond promptly and effectively to an eligible emergency. Potential negative impacts may occur because of the presence of Indigenous and Afro-Nicaraguan Peoples in the project area. An indigenous and Afro-Nicaraguan Peoples Planning Framework (IAPPF) will be prepared by the EMERGENCY SOCIAL INVESTMENT FUND (FISE), and Indigenous and Afro-Nicaraguan Peoples Plans (IAPP) will be submitted for approval prior to the construction of any public works.